Talk of income inequality has become all the rage in politics these days — with good reason.

We long ago entered a second Gilded Age, with the widest wealth gap in history between middle class and upper-income families. For those at the bottom, efforts to increase the minimum wage have mobilized workers and succeeded across the country. And not just in progressive places like Seattle; 66 percent of Arkansas voters approved a minimum wage increase in 2014 even as they ousted their only remaining Democratic U.S. senator.

What’s not mentioned by politicians, however, is the degree to which government itself drives income inequality. Consider bipartisan disregard for the medically indigent: After pushing to expand Medicaid, the Obama administration worked alongside states to persuade the U.S. Supreme Court to deny Medicaid providers the right to use the courts to pursue adequate compensation.

In our state, where reimbursement for the roughly two-thirds of nursing home patients on Medicaid is still stuck on 2007 costs, the state budget only appropriated a nickel-a-day increase for patients, even as it expects many facilities to gear up to hire more caregivers thanks to a new state mandate. As most Medicaid costs are wages — for direct caregivers and support services such as housekeeping or kitchen workers — wages in Washington state have objectively been depressed by government itself. And most of the affected wage-earners are women — very often single moms.

Now the Obama administration is poised to inflict further injury, with unique implications for Skagit County, Snohomish County’s neighbor to the north. Medicare pays fully for nursing home care for 20 days after a three-day hospital stay, and it pays much more fairly than state-based Medicaid. Medicare payments are tied to the acuity of the patients, but must also account for area differences in wages; the labor-related share of cost is roughly 70 percent of the patient-adjusted Medicare rate. For Skagit County’s five nursing homes this calculation is a disaster. Due to poor methodology, the annual change in Medicare rates as of Oct. 1 will continue to put Skagit County at the bottom of the state, $82.57 per patient, per day beneath even the catch-all “Rural” wage index.

In effect, for Medicare wage purposes, the Obama Administration treats expensive Anacortes as having lower caregiver wages than, say, Omak or, for that matter, any other small town you can name outside Skagit County (ironically, Skagit County’s hospitals receive Seattle’s Medicare wage index). This will worsen the situation created by Medicaid shortfalls. Chronic state underfunding already forced the closure of a long-time family-owned facility in Oak Harbor, leaving the 39 miles between Coupeville and Mount Vernon served by two small family-owned Anacortes facilities. The other Skagit County facilities include two in Mount Vernon and one in Sedro-Woolley.

Meanwhile, federal Medicare funding for nursing home patients was already reduced 2 percent, apparently forever, thanks to the “sequestration” budget doomsday device both parties in Congress agreed to. Why should the federal government make Skagit County’s most vulnerable citizens suffer any further due to faulty wage calculations for their caregivers? There is still time for the Obama Administration to elevate Skagit County caregivers, not inadvertently destroy their living wage dreams.

Olympia attorney Brendan Williams is a former state representative (2005-10) and a long-term care advocate.